Purpose :
To determine practice patterns among Canadian vitreoretinal surgeons (VRS) in the management of symptomatic vitreous floaters (VF).

Methods :
A 20-question survey was distributed online via SurveyMonkey ® to all currently practicing Canadian VRS, based on Canadian Retina Society membership.

Results :
The response rate was 35.5% (33/93). Respondents were predominantly male (97%, 32/33) and most (93.9%, 31/33) held an academic appointment at a teaching hospital. 21 of 33 respondents (63.6%) have been in practice for over 10 years (median 11-20 years) and perform approximately 6-10 vitrectomies per week.

One of 33 respondents (3%) would never offer vitrectomy for symptomatic VF, whereas 29 of 33 (87.9%) have performed it, and 3 of 33 (9.1%) have not but would consider offering it. Of those who have performed vitrectomy for VF, 17 of 29 (58.6%) have done more than 5 cases. The decision to offer vitrectomy was based on the severity of self-reported symptoms (31/32, 97%), and most VRS (27/32, 84.4%) require at least 4-6 months of active symptoms before offering surgery. One of 32 respondents (3.1%) quantifies VF symptoms through formal contrast sensitivity measurement.

Respondents were more likely to offer vitrectomy if the patient was over 50 years of age (18/32, 56.3%) or pseudophakic (19/32, 59.4%). In phakic patients over 50 years of age, 22 of 32 respondents (68.8%) recommend only vitrectomy without anticipatory cataract extraction. In contrast, 7 of 32 (21.9%) prefer combined cataract extraction and vitrectomy, and 9.4% (3/32) prefer cataract extraction prior to vitrectomy. Twenty-four of 32 (75%) use small-gauge vitrectomy exclusively. Intraoperatively, 26 of 32 (81.3%) will induce a posterior vitreous detachment if it is not present. Surgical outcome is primarily determined by patient self-reported improvement (31/32, 96.9%).

Conclusions :
Many Canadian VRS have performed or would offer vitrectomy to patients with symptomatic VF. This decision appears to be approached conservatively, with most requiring a significant period of symptom observation, utilizing only small gauge vitrectomy, recommending only vitrectomy without anticipatory cataract surgery, but performing as complete a vitrectomy as possible. Preoperative symptom assessment and postoperative outcome are almost always based solely on subjective accounts by the patients, with contrast measurements rarely being utilized.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.